Theme: Epidemiology & Public Health Research Year: 2024
Background: There is a concentration of people living with HIV and opioid use disorder (OUD) in criminal justice settings (CJS). In Moldova, efforts towards decarceration have led to more people on probation which serves as a form of community-based supervision. Among people on probation there are higher levels of substance use and mental health disorders compared to the general population, but access to evidence-based OUD treatments like opioid agonist therapy (OAT) remains low. We hypothesized that the probation period could serve as a key entry point to OAT treatment and assist in identifying and treating other co-morbid conditions like HIV.
Methods: This study was conducted at 10 probation centers across Moldova between November 2019 to April 2023. We conducted a single arm modified screening, brief intervention and referral treatment (SBIRT) strategy to identify people on probation with OUD and link them to OAT. Among those who screened positive for OUD, we assessed interest in OAT pre- and post-brief intervention. OAT-interested participants were referred to OAT services. Participants underwent HIV, HCV, HBV, and syphilis testing.
Results: Of the 900 consecutive entrants screened in probation, 15.1% (N = 136) met diagnostic criteria for OUD. 119 participants were eligible for and enrolled in the brief intervention. Twenty-seven (22.7%) tested positive for HIV, with 7 (25.9%) of them being newly diagnosed during study procedures. Interest in starting OAT did not change after the brief intervention. Thirty-three (N=33, 27.7%) of participants initiated OAT and 32 (97%) were on OAT at 6-month follow-up.
Conclusion: In Moldova, the prevalence of OUD and HIV is high among people on probation. SBIRT can rapidly identify and link to care people with OUD who are interested in OAT. Future studies are needed to promote implementation and scale-up of SBIRT by understanding how to increase interest in OAT and HIV services.